Mistreatment and the Learning Environment: A Mixed Methods Approach to Assess Knowledge and Raise Awareness Amongst Residents.

OBJECTIVE: Trainee mistreatment, either intentional or unintentional, negatively affects the learning environment. This study was undertaken to evaluate the impact of an educational intervention about mistreatment and the learning environment on general surgery residents.

DESIGN: Video-based modules were developed and added to the residency curriculum. Modules provided definitions and examples of active and passive mistreatment and components of positive and negative learning environments. A mixed-methods approach was used to assess the impact of this intervention. Residents completed a previously validated pre and post-test of related knowledge and attitudes (Abuse Sensitivity Questionnaire). Wilcoxon Signed Rank test was used to compare test results. During video-review sessions, discussion was prompted amongst residents using a semistructured interview guide. Immersion crystallization method was used to identify dominant themes.

SETTING: Beth Israel Deaconess Medical Center, an academic tertiary care facility located in Boston, Massachusetts.

PARTICIPANTS: All general surgery residents in our institution (n = 58) were invited to complete a survey at 3 time points.

RESULTS: Fifty-eight residents (55% male) responded to the survey (100% response rate). Mean age was 30.2 year (SD 3.9). Perception of nicknames related to personal identifiers (p = 0.0065) and name-calling (p = 0.02) changed significantly postintervention (Table 1). Regarding standards of behavior, 42 (72.4%) residents considered yelling not to be abusive unless it occurred frequently or constantly; 15 (25.8%) residents considered swearing (not directed at a person) as "not abuse"; 6 (10.3%) considered constructive criticism to be abusive if it was frequent or constant; and 24 (41%) residents feel powerless to intervene in these scenarios. Multiple themes emerged regarding resident-student interactions: (1) resident perception that description of behavior as mistreatment depends on medical student sensitivity; (2) neglect of medical students avoids trouble (e.g., being labeled as active mistreatment); (3) failure to integrate students into the surgical team may occur due to perceived lack of student interest; and (4) communication with the medical student is key. Residents reported that discussion along with video review was more effective than video review alone.

CONCLUSIONS: The video-based curriculum on mistreatment and the learning environment created awareness amongst residents about this important topic. Knowledge and attitudes about mistreatment changed in some areas postintervention. These findings suggest a need for development of complementary curricula to improve resident awareness and understanding of components of a positive learning environment and definition/examples of mistreatment.